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Wyświetlanie 1-10 z 74
Tytuł:
Incidence and role of recipient-specific antibodies in allogeneic hematopoietic cell transplantation from mismatched related donors
Autorzy:
Piekarska, Agnieszka
Dukat-Mazurek, Anna
Zaucha, Jan Maciej
Moszkowska, Grażyna
Dębska-Zielkowska, Joanna
Mensah-Glanowska, Patrycja
Sadowska-Klasa, Alicja
Zielińska, Hanna
Opis:
High titer of donor-specific antibodies (DSAs) increases the risk of graft rejection after mismatched related hematopoietic cell transplantation (HCT). There are no data regarding the incidence of anti-HLA recipient-specific antibodies (RSAs) and their role after transplantation. Here we aimed to identify the incidence of RSAs in a mismatched related hematopoietic cell donor population and their possible impact on immune-mediated complications, such as acute graft-versus-host disease (aGVHD), and complications resulting from endothelial injury, such as transplantation-associated thrombotic microangiopathy (TA-TMA) and veno-occlusive disease (VOD). We prospectively analyzed the incidence of anti-HLA antibodies in 28 mismatched related pairs of recipients and their donors who underwent HCT at our center between 2020 and 2022. In positive samples screened for anti-HLA class I and/or II antibodies, the specificity of the HLA antibodies was analyzed. All recipients had a hematologic malignancy and received a myeloablative conditioning regimen and immunosuppression consisting of post-transplantation cyclophosphamide, tacrolimus, and mycophenolate mofetil. Patients were tested for TA-TMA and aGVHD development during routine post-transplantation visits up to 100 days posttransplantation. We used modified Jodele criteria for TA-TMA diagnosis, and based aGVHD grading on the MAGIC criteria. VOD was assessed using the European Society for Blood and Marrow Transplantation. Anti-HLA antibodies were detected in 12 donors (43%) and in 9 recipients (32%). There were no significant differences between donors and recipients according to age (median, 42 years [range, 17 to 69 years] versus 39 years [range, 8 to 68 years]), sex, or pregnancy history. No transfusion history was noted in the donor group (P < .05). RSA antibodies were present more often than DSAs and were detected in 9 out of 12 (75%) anti-HLA-positive donors and in only 2 out of 9 (22%) recipients, respectively (P < .05). During the follow-up, 11 patients (39%) developed aGVHD, including grade I-II in 9 (32%) and grade III-IV in 2 (7%). Twelve patients (43%) met the criteria for TA-TMA, and only 1 patient (3.5%) was diagnosed with VOD by day 100 post-HCT. RSAs were detected significantly more often in the TA-TMA group; among 12 patients diagnosed with TA-TMA, 7 (58%) had RSAs (P < .05). We did not find a correlation between RSAs and aGVHD. The patient with VOD did not have an RSA-positive donor. There was no difference in membrane attack complex (MAC) concentration in the RSA-positive group on day 30 and day 60 post-HCT; however, there was a trend toward higher MAC concentration in the RSApositive group on day 100 (median, 912 ng/mL [range, 788 to 1120 ng/mL] versus 616 ng/mL [range, 352 to 1244 ng/mL]; P = .055). Patients with RSA suffered more often from platelet and red blood cell decreases or transfusion refractoriness, and increased lactate dehydrogenase activity was observed in all RSA-positive cases. The donor immune status and the presence of RSA may be associated with higher rates of TA-TMA in mismatched HCT recipients. Antibody-mediated complement activation might be an additional factor influencing TA-TMA occurrence.
Dostawca treści:
Repozytorium Uniwersytetu Jagiellońskiego
Artykuł
Tytuł:
Rola rytuksymabu w leczeniu pierwszego rzutu chłoniaka rozlanego z dużych komórek B dużego ryzyka : analiza retrospektywna Polskiej Grupy Badawczej Chłoniaków
Role of rituximab in the first-line therapy of high-risk diffuse large B-cell lymphoma : a retrospective analysis by the Polish Lymphoma Research Group
Autorzy:
Wróbel, Tomasz
Giza, Agnieszka
Knopińska-Posłuszny, Wanda
Stella-Hołowiecka, Beata
Górecki, Tomasz
Zimowska-Curyło, Dagmara
Boguradzki, Piotr
Joks, Monika
Zaucha, Jan M.
Ochrem, Bogdan
Jurczak, Wojciech
Walewski, Jan
Opis:
WPROWADZENIE Immunochemioterapia R‑CHOP (rytuksymab, cyklofosfamid, doksorubicyna, winkrystyna, prednizon) jest standardem leczenia pierwszego rzutu w przypadku chłoniaka rozlanego z dużych komórek B (diffuse large B‑cell lymphoma – DLBCL). Żadne z badań randomizowanych nie udowodniło istotnej statystycznie korzyści w zakresie całkowitego przeżycia (overall survival – OS) w podgrupie dużego ryzyka wg Międzynarodowego Wskaźnika Prognostycznego (International Prognostic Index, IPI). CELE Zbadaliśmy retrospektywnie rolę dodania rytuksymabu do chemioterapii opartej na antracyklinie u chorych z DLBCL dużego ryzyka wg IPI. PACJENCI I METODY 371 chorych z DLBCL dużego ryzyka leczonych w 15 polskich ośrodkach hematologicznych poddano retrospektywnie analizie w dwóch odrębnych grupach wiekowych: >60 i ≤60 rż. Porównywano i analizowano odsetki odpowiedzi na leczenie, OS i przeżycie wolne od progresji (progression‑free survival – PFS). WYNIKI Całkowity odsetek odpowiedzi (overall response rate – ORR) u chorych z DLBCL dużego ryzyka istotnie zwiększył się u chorych leczonych rytuksymabem w porównaniu z chorymi leczonymi bez rytuksymabu (76,7% vs 95,6%; p <0,05). Immunochemioterapia R‑CHOP wydłużyła przeżycie zarówno w młodszej, jak i starszej podgrupie chorych. 5‑letnie rzutowane OS i PFS młodszych chorych leczonych rytuksymabem vs samą chemioterapią wynosiły odpowiednio: 42% vs 38% i 46% vs 27% (p <0,05), natomiast 5‑letnie rzutowane OS i PFS starszych chorych leczonych rytuksymabem vs samą chemioterapią wynosiły odpowiednio: 82% vs 52% i 67% vs 45% (p <0,05). WNIOSKI Z uwzględnieniem wszystkich ograniczeń analizy retrospektywnej, przewaga dodania rytuksymabu do chemioterapii skojarzonej CHOP została wyraźnie wykazana odnośnie do ORR, OS i PFS w obu podgrupach wiekowych pacjentów z DLBCL dużego ryzyka.
INTRODUCTION R-CHOP immunochemotherapy (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) is a standard first-line treatment for diffuse large B-cell lymphoma (DLBCL). None of the randomized trials have proved a statistically significant overall survival (OS) benefit in high-risk subgroups according to the International Prognostic Index (IPI). OBJECTIVES We retrospectively investigated the role of adding rituximab to anthracycline-based chemotherapy in patients with high-risk DLBCL according to the IPI. PATIENTS AND METHODS A total of 371 patients with high-risk DLBCL treated at 15 Polish hematology centers were retrospectively analyzed in 2 distinct age groups: older than 60 years and 60 years old or younger. Response rates, OS, and progression-free survival (PFS) were compared and analyzed. RESULTS The overall response rate (ORR) of high-risk DLBCL patients significantly improved in rituximabtreated patients compared with patients treated without rituximab (76.7% vs 95.6%; P <0.05). The R-CHOP immunochemotherapy prolonged survival in both older and younger subgroups. The 5-year projected OS and PFS in younger patients treated with rituximab vs chemotherapy alone were 42% vs 38% and 46% vs 27%, respectively (P <0.05), while the 5-year projected OS and PFS in older patients treated with rituximab vs chemotherapy alone were 82% vs 52% and 67% vs 45%, respectively (P <0.05). CONCLUSIONS With all the limitations of a retrospective analysis, the superiority of adding rituximab to CHOP combination chemotherapy has been clearly demonstrated regarding ORR, OS, and PFS in both age subgroups of patients with high-risk DLBCL.
Dostawca treści:
Repozytorium Uniwersytetu Jagiellońskiego
Artykuł
Tytuł:
A survey across orbital lymphoma in Poland : multicenter retrospective study of polish lymphoma research group (PLRG)
Autorzy:
Kalicińska, Elżbieta
Wróbel, Tomasz
Giza, Agnieszka
Balcerzak, Andrzej
Jabłonowska, Paula
Knopińska-Posłuszny, Wanda
Rybka, Justyna
Paszkiewicz-Kozik, Ewa
Wojnar, Jerzy
Giebel, Sebastian
Romejko-Jarosińska, Joanna
Spychałowicz, Wojciech
Zaucha, Jan Maciej
Zimowska-Curyło, Dagmara
Andrasiak, Iga
Opis:
Objective: To investigate the prevalence of histopathological subtypes, the clinical stage at presentation and treatment modalities in Polish patients with orbital lymphoma (OL) and to determine prognostic outcomes. Methods:The retrospective study of 107 patients with OL treated in a 14-year period in Polish hematological centers. The analysis included histopathological subtype, disease clinical advancement, treatment modalities, progression-free survival (PFS), and overall survival (OS). Results: The median patient age was 60 years (range 51–71). Mucosa-associated lymphoid tissue (MALT) lymphoma accounted for slightly more than half of all cases of orbital lymphoma (51%). The second most common subtype was diffuse large B-cell lymphoma (DLBCL) (29%). Primary orbital lymphoma was diagnosed in 48% of all patients. According to the Ann Arbor, localized stage IE of orbital lymphoma was diagnosed only in 39% of all patients. Systemic involvement was observed in more than half of all patients (52%). The median follow-up period was 30 months (range 0–160 months). Patients with non-MALT lymphoma had a significantly inferior PFS compared to patients with MALT lymphoma, (p = 0.047). Patients with primary orbital lymphoma had a superior PFS compared to patients with secondary orbital lymphoma [median PFS 104.5 months vs. 33.4 months], (p = 0.069). Younger patients with MALT lymphoma were characterized by superior PFS (median PFS not reached) compared to other studied subgroups of patients (older patients with MALT lymphoma, younger and older non-MALT lymphoma patients) with a median PFS of 30.5, 32.2, 32.6 months respectively (p = 0.039). Patients treated with chemotherapy alone had inferior PFS compared to patients treated with combined therapies (p = 0.034). The median PFS across patients who received chemotherapy alone was 23.7 months, whereas across other patients was 73.9 months.
Dostawca treści:
Repozytorium Uniwersytetu Jagiellońskiego
Artykuł
Wyświetlanie 1-10 z 74

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